Spermatocele Following Kidney Transplant

Lymphocele following kidney transplant is a common occurrence, but on occasion, what appears to be a lymphocele is not. We present an unusual case of a kidney transplant recipient whose presumed lymphocele was actually a spermatocele. Our patient is a 60‐year‐old man who is 11 years status post his second deceased donor kidney transplant. The original cause of his renal failure was poststreptococcal glomerulonephritis. He was followed with this nonobstructing lymphocele for years, but wished to have it addressed at the time of sigmoidectomy for recurrent diverticulitis. Preoperative imaging included CT scan, which showed a 12 cm × 6 cm collection, of greater density than simple fluid, adjacent to the bladder, and causing mass effect on the bladder. Intraoperatively, the collection was somewhat atypical for a lymphocele, and located posterior to the bladder. Cultures were negative, but evaluation of the fluid revealed it to be a spermatocele. Postoperative ultrasound demonstrated full resolution of the collection.     

The rapid diagnosis of infectious mononucleosis using an ELISA that detects IgM antibody to a peptide component of Epstein-Barr virus nuclear antigen.

An enzyme-linked immunosorbent assay (ELISA) that detects IgM antibody to a peptide component of the Epstein-Barr virus (EBV) nuclear antigen (EBNA-1) was compared with a conventional rapid heterophil antibody method for the rapid diagnosis of infectious mononucleosis. Discrepancies between the two methods were further analyzed using an indirect immunofluorescence assay to detect antibodies to EBV antigens. We evaluated 298 cases of suspected infectious mononucleosis. The ELISA was very sensitive (98.7%) and able to detect some cases (seven (9%) of 75 confirmed positives) that were negative by the rapid heterophil antibody test, but confirmed by immunofluorescence. However, approximately 17% of all positive tests could not be confirmed by EBV-specific immunofluorescence; thus, the overall positive predictive value was 83%; negative predictive value was 99.5%; and specificity was 93%. The high rate of false-positive tests makes this rapid ELISA unsuitable for the diagnosis of infectious mononucleosis.     

Psychological health in patients with genital and oral erosive lichen planus

BACKGROUND: Erosive lichen planus is a severe, recurrent and recalcitrant disease that affects several mucosal areas, mostly the genital area and the mouth, but also, for example, the oesophagus and perianal area. The disease causes serious symptoms, because of the raw, de-epithelialized mucosa and healing with scars/adhesions, which affect the patient's life in many ways. It causes, for example, difficulties in eating, drinking and going to the bathroom. Treatment is complicated and, so far, few therapeutic drugs other than steroids have been reported. OBJECTIVES: As the disease has severe implications on the patient's life it is important to investigate the psychological health of the patients, as well as the influence of stress on their health and wellbeing, in order to improve treatment. STUDY DESIGN, SUBJECTS AND METHODS: Forty-nine consecutive patients with erosive lichen planus were included during a 1-year period. The study was carried out as 'state-of-the-last-month', and stress, state anxiety, depression and 'erosive lichen planus factors', i.e. symptoms affecting daily life, were assessed. RESULTS: Eighty-seven per cent of the patients had symptoms, severely affecting daily life. Unexpectedly, oral symptoms seemed to be the most prominent. Our results showed that depression, anxiety and stress were more common in patients with erosive lichen planus than in a control group. DISCUSSION AND CONCLUSIONS: Erosive lichen planus is a severe disease with symptoms and complications affecting the patient's life. Our results indicate that their psychological health is also affected and emphasize the need for close collaboration between physicians, dentists with special knowledge in oral medicine and counsellors/psychologists to optimize handling of these patients.     

四种中药方剂对全血化学发光和活性氧的抑制作用

目的：从抗氧化角度,研究中药方剂抗衰老的作用。方法：运用化学发光分析方法,测定了４种中药方剂体外对全血化学发光的影响,并研究了其对活性氧的抑制作用。结果：４种中药方剂在体外能明显抑制白细胞吞噬氧化作用所引发的化学发光强度,可清除超氧阴离子自由基、羟基自由基、过氧化氢、且呈量效关系。结论：这４种中药方剂对活性氧具有清除作用,这些方剂抗衰老作用的机理可能与其具有抗氧化作用有关。     

Surgical resident perspective on deceased donor organ procurement

Background

Deceased donor organ procurement provides unparalleled opportunity for surgical residents with extensive surgical exposure. We hypothesize that surgical residents regard organ donation positively and organ procurement enhances their education.

Methods

We conducted an institutional review board approved anonymous national survey to evaluate organ procurement experiences and attitudes of general surgical residents.

Results

Three hundred ninety-seven residents representing all postgraduate years responded, with 97% completion rate. Organ procurement increased with training level (92% seniors vs 53% interns). Over 85% agree organ procurement is a good educational and operative experience, and 73% believe that it will benefit their future surgical career. About 68% agree that organ procurement provided knowledge of anatomy and exposures; under 10% felt organ procurement could be duplicated with simulation. Presence of transplant program did not affect attitudes or experience. Eighty-eight percent women versus77% men plan to donate their own organs.

Conclusion

Results indicate that surgical residents value organ procurement, and it remains an essential encounter that applies to general surgery.     

控释胶质细胞源性神经营养因子对骨髓间质干细胞源性神经元样细胞移植修复猴脊髓轴突的协同作用

目的:采用甘氨酸银浸镀法评价控释胶质细胞源性神经营养因子与骨髓间质干细胞源性神经元样细胞联合移植后,其对猕猴脊髓损伤后轴突的修复效果是否优于单纯神经元样细胞移植。方法:实验于2006-03/08在北京市垂杨柳医院病理科完成。①选择2004-01/2005-01中山大学邓宇斌教授课题组研究的猴脊髓石蜡标本12例作为回顾性实验分析对象,其中控释神经营养因子 神经元样细胞联合移植组4例、单纯神经元样细胞移植组4例、磷酸盐缓冲液对照组4例。课题前期实验各组动物均建立急性重度脊髓损伤模型,并于造模后第10天给予对应细胞悬液。②各组每例石蜡标本均制备连续切片3张,片厚0.4μm,对所有切片进行一次性甘氨酸银浸镀法染色。具体步骤:切片脱蜡入水,酸性甲醛液处理10min,蒸馏水清洗后,置于甘氨酸银溶液中,37℃作用5min。取出切片,用滤纸吸干多余银液,入预热45℃的还原液作用1min。用乙醇洗切片10min,再行蒸馏水冲洗,入氯化金水溶液5min,直到棕黄色脱去。滴入苯胺油乙醇液加强染色,冲洗。50g/L硫代硫酸钠液处理30s,冲洗,梯度乙醇脱水,然后在石碳酸二甲苯中浸泡2min,二甲苯透明,中性树胶封固。③应用图像分析系统进行检测,观察各组皮质脊髓束纵切面病理改变,统计每个视野内上行性(后索)与下行性(皮质脊髓束)横切面轴突的数量及横、纵切面面积,取切片两侧各5个非重叠视野,计算平均吸光度值。结果:①各组脊髓损伤处轴突病理改变:控释神经营养因子 神经元样细胞联合移植组皮质脊髓束纵切面部分区域存在较多连续性的轴突;磷酸盐缓冲液对照组脊髓结构破坏严重,轴突大面积消失,纵切面可见崩解的轴突碎片,几乎观察不到连续性轴突;单纯神经元样细胞移植组的变化介于两者之间。②后索与皮质脊髓束的横切面轴突数量、横切面面积、纵切面面积、平均吸光度:控释神经营养因子 神经元样细胞联合移植组、单纯神经元样细胞移植组后索与皮质脊髓束各项检测指标均高于磷酸盐缓冲液对照组,3组间比较差异有显著性意义(F=38.45～487.54,P均<0.01;F=52.66～313.99,P均<0.01)。控释神经营养因子 神经元样细胞联合移植组与单纯神经元样细胞移植组比较,前者对后索轴突的修复作用略优于后者,表现在纵切面面积显著升高(P<0.01);对皮质脊髓束的修复作用明显强于后者,轴突数量、横切面面积、纵切面面积、平均吸光度值差异均有显著性意义(P<0.01或P<0.05)。结论:控释胶质细胞源性神经营养因子可以增强骨髓间质干细胞源性神经元样细胞对猕猴损伤脊髓轴突的修复作用,尤其有利于运动性损伤轴突的修复,其效果优于单纯神经元样细胞移植。     

有自杀行为的单、双相抑郁症患者父母育龄及胎次效应比较

目的:比较有自杀行为的单、双相抑郁症患者间父母育龄及胎次效应的差异。方法:于1983-07/2003-06选择无锡市精神卫生中心门诊和住院符合中国精神疾病分类方案与诊断标准第3版及美国精神障碍诊断和统计手册第4版心境障碍中抑郁发作标准的、无严重躯体疾病或脑器质性疾病的抑郁患者。有自杀行为的单相抑郁症患者家系59例,双相抑郁症患者家系31例。采用自行编制的精神病家系调查表(内容主要包括患者及一级亲属所有成员社会人口学资料、疾病发作特点及次数、自杀情况),由两名主治医师或以上的研究人员对每一家系进行调查,然后再由两名研究人员在互不知情的情况下对每一患者进行再诊断。对所有先症者及一级亲属中有自杀行为者进行面检(面检率>95%);对无自杀行为的一级亲属则进行信函调查(53%)及面检(47%)。已死亡及不能进行面检者的资料由一两名一级亲属提供有关情况填写调查表。用Haldance和Smith法观察有自杀行为的单相抑郁症患者及双相抑郁症患者父母育龄及胎次的效应。结果:符合入组诊断标准者共151例,完成家系调查的共122例,其中纳入分析的单相抑郁症家系59例,双相抑郁症家系31例。①单相抑郁症患者胎次为1的13例,胎次为2的15例,胎次为3的13例,胎次为4的8例,胎次为5的8例,胎次为7的2例;双相抑郁症患者胎次为1的10例,胎次为2的11例,胎次为3的7例,胎次为4的1例,胎次为5的2例,胎次为7的0例。②有自杀行为单相抑郁症患者与父母育龄及胎次的关系非常显著(C=2.4>2,P<0.01,6A>X6A);有自杀行为双相抑郁症患者与父母育龄及胎次无显著关系(C=0.74<2,P>0.05)。结论:单相抑郁症患者父母育龄越大和胎次越高者易发生自杀行为,双相抑郁症患者父母育龄和胎次自杀行为的发生无明显关系。提示适龄婚育对防止单相抑郁症自杀行为的发生具有重要意义。